I’d first heard about him several months ago. His has been a complex story, and truth be told, he shouldn’t be alive. He has had several near-misses, although there has apparently been much-heated disagreement among him and some of his treaters as to where “accidental” ended and “purposeful” began. Still, he’s pretty much the straight-shooter: he readily admits that sometimes the latter is the only adjective worthy of at least a few of his tête-à-têtes, shall we call them, with the Great Specter from Beyond.

He came to me for Suboxone, the new opiate substitution regimen that has proven so helpful for many combat veterans who have struggled with addictions to painkillers and heroin since their return from The War. Like many of his fellow veterans, he has endured chronic pain both of a physical variety and of an emotional one. He has also long complained of very marked, almost continuous anxiety, an anxiety that, true, sometimes has had the quality of the hypervigilance so characteristic of the combat veteran who just can’t seem to get off guard duty, but at most times has simply seemed to be (to me, at least) a dramatic, post-combat upsizing of the chronic tension and energy that has been his hallmark since toddlerhood.

He has not been, what, particularly enamored with us at our VA. He’s willing to admit, though, that he’s not always been, what, particularly enamoring himself. When so much pain is ricocheting through a room as a combat veteran struggles with the acute emotional challenges of posttraumatic stress injury, both veteran and treaters can sometimes get caught up in the tornado-esque swirls of suffering. We treaters do our best not to get so caught up, but indeed, we’re human, and humans catch emotions from each other, especially powerful ones, and since most of us went into the field precisely because we are good at experiencing the emotions of others, even the most calm and patient of clinicians can, at times, feel a bit unhinged in the midst of tense situations.

We had no such experiences together when we met, though. He was pleasant, though (appropriately) wary. I had no doubts whatsoever as to the sincerity of his desire to find a more satisfying solution to all his pains, for his relationships have suffered tremendously because of them. I also had no doubts whatsoever that he can get quite ugly quite quickly, and both he and his wife had no problems whatsoever acknowledging that very fact. He knew he needed help. His wife knew it. I knew it. We came to a “meeting of the minds” quickly as to the medication.

But I will remember my encounter today with him not because of Suboxone.

Several months ago I wrote a post entitled Cluster B Traits. Only one other post, The Killing Floor, has received more hits. As of today, that post has been visited a total of 557 times. In fact my new claim to fame is that if you Google “cluster B traits,” my post comes up fourth (some days, third) on the list after Wikipedia, Answers.Yahoo.Com, and another blog post!

I’m kind of impressed with myself, if do so say.

All these months later, I still have my reservations using that label (“cluster B traits”) with combat veterans. My patient today, for example, has been the recipient of that label more than once. He has, in fact, read page after page of his medical record, and he has more than noticed how frequently he has been given the honor of that quasi-diagnosis.

He has not been impressed.

Quite the contrary: he told me that he now finally understands why so many treaters at our VA have been, in his words, “less than supportive,” especially of his medical concerns. “If you have a ‘personality problem,’” he said, “people just assume you’re trying to get something over on them. I mean, that’s what I would think if I read that, you know what I mean?”

And . . . well . . . while I might say that he may be being a bit harsh and overgeneralizing with that claim . . . well . . .

I wouldn’t say that too vociferously.

Instead, I had him consider an alternative interpretation.

“But isn’t it a fact that you’ve felt this inner tension ever since you were a boy?” I asked.

“Yeah. So?”

“So wouldn’t it make much more sense to call it for what it feels like, that is, lik too much adrenaline flowing through you all the time?”

That stopped him cold. Apparently he’d not been expecting that from me.

“I’ve seen it with a lot of you guys in the military,” I continued. “Ever since you were kids, you’ve had a motor running. People usually called you ‘hyperactive,’ but that wasn’t quite right, was it? It wasn’t so much that you couldn’t focus as it was that you couldn’t focus on the routine or the trivial. If you found something that really interested you and allowed you to work out your energy, live it, love it, you could actually be quite focused. True?”

He just stared at me.

Then I saw it. His eyes began to well up.

He turned away from me slightly, looked down. He brushed the edge of his right hand against the edge of the corresponding eye, swallowed. Still he still looked down.

“Isn’t that true, though?” I asked again, though a bit more genly this time. “That it’s always just been so much to handle on the inside of you, that the military took care of that, gave you something meaningful to do with all that, rewarded it?”

He looked up. Whether he was fighting the tears or just not caring what happened anywhere north of his lips, I couldn’t quite tell.

“I wish other people understood that,” he whispered.

“Not even your wife does?” I asked.

He was still looking right at me, every microfiber of muscle still.

“I don’t know,” he finally said. “I think she tries, but I don’t know. Nobody else does. You don’t know how I fought to stay in the military. They tried so hard to med board me out, and I fought it and I fought it and fought it, until finally I had to go. You don’t know what I’d give to get back over there.”

“Because it all fit over there, didn’t it?”

“God, yes. I loved what I did. I was good at it. I didn’t want to kill people, hurt people, destroy things. I didn’t try to do it. But I protected myself, protected my men. We did what we had to do. We saved a lot of lives over there. Now I’m just here.”

“And inside you, the motor keeps running, on and on and on,” I said, myself whispering now. “And it’s eating you alive.”

He just nodded. What else could the guy have done.

He’s quite the handful. Always has been. Yet character-disordered? Cluster B traits? Oh, sure, I could make the argument as well as colleagues could: the veteran’s longstanding difficulties, his interpersonal challenges, his “persistent unwillingness” to look inward and “fix” it, whatever that it might be, “tame” it, “reflect” on it, “soothe” it.

Unwilling? Or unable?

Yes, he loves his energy, his adrenaline, his push, push, push into the world, now, again, again, harder. He feels alive with it. He feels real.

But he’s no fool.

He knows that we don’t cotton too much to such energy back here in the civilian world, even if we say that we like our boys or girls to be “Army tough”, Semper Fi. You leave that out on the playground, child, you hear? Run that out of you and then get back in here and get to work.

You go do your military thing, man, woman. Run that out of you. “Thank you for your service,” we’ll say. Shoot, we’ll even give you a parade or two (the Fourth’s coming up, you know).

Then get back in here and get to work.

And we wonder why he turns to pain pills to ease the pain. All that energy, we say, if he would just use it right, ‘tis a pity .

Use it? Really? Where?

You gonna put up with his constant edginess, Mr./Ms. Civilian? You gonna give him that opportunity to punch that bag, run that ten miles, pump that iron–even if maybe you might lose an hour of work out of him to let him do so?

You gonna tell him he’s a good man, that even when he’s a handful, yes, even when you’ll exhale quite the sigh of relief whenever he’s bounces out to do whatever it is he needs to do “get that out of you, boy, go on, go, go, go!, you’ll tell him that you’re so glad that he’s here, that you wouldn’t want him any other way? (Well, all right, most times . . .)

They just want to be understood, you know, these men and women with that Army-tough, Semper-Fi drive, energy, passion. They know they’re a handful. They know they’ve got too many hormones and neurotransmitters hurtling through their arteries and veins, banging on the doors of their neurons as if there were no tomorrow, ordering every cell within the vicinity to “move this sucker, baby, and I mean now!”

They know they’re not “normal,” i.e., not like most of us on the remainder of the bell curve. You think you’re gracing them with some eye-popping epiphany when you label them “hyper” or “emotionally dysregulated”?

Actually, I’ve found them to be quite a forgiving bunch, if you want to know the truth. You can label them whatever, from my experience–just as long as you can smile and like them, give them the space they need, the passionate direction they need to allow them to burn up a few of them inner chemicals so that, maybe, tonight? We could just chill a bit, you know? Be friends? Talk?

“Now, true,” he or she might then say, “I’ll do most of the talking, but . . .”

Please don’t blame them for their bodies’ chemical composition. Please don’t abandon them to some poor spouse or some few kids who cannot deal with this all on their own, who are are just going to need a break every once in a while–and not just talking every few weeks here.

It takes a village, a village that’s willing to adjust its work schedules, willing to say up front “We understand. We’ll work with you.” Willing then to do just that. I can’t help but wonder what would happen to those veterans’ “Cluster B Traits” if that were to happen.

Well, actually, I don’t wonder, but then . . . I’m one of those types, you know, unwilling to call pathology when I see it, unwilling to set limits that must be set in order for an individual to learn to function in society, after all.